Improving Health Literacy: It’s About Empowerment

In my last post, I noted some considerations for improving health literacy. In the next several posts, I’ll consider some instructional design issues that arise when developing health-related educational materials for learners who are not health care professionals and who may or may not have taken a biology course since high school.

I’m avoiding using the term “patient” in this discussion because while we’re all patients at one time or another, it’s not a continuous state and generally people don’t view themselves as patients in their daily lives. The term “health consumers” implies that learners are some marketing demographic. “Health activist” is also a term I considered, but it implies a level of engagement that I’m not going to assume all learners have.

Why the words matter

Why am I spending so much time explaining terminology I’m not going to use? I think it’s an important example of what should be in the forefront of our minds as we design health-related learning. We need to consider the demographics and attitudes of our learning audience. This is a heterogeneous group of people and while you can’t create truly universal learning modules, if you provide tools learners can use to create individual learning experiences, you’re more likely to maintain motivation and accomplish learning objectives.

It is all about empowerment

“Empowerment” is something of a buzzword in the health care field these days. My take is that being empowered means you are the owner and manager of your own health care strategy. This implies more than merely having an active interest in accessing health information online, it means being able to use this information.With this in mind, I submit that the ideal role of a health information Web site is not to simply push information at users of the site, but to provide users with the tools and skills they need to effectively pull information when and where they need it. I also submit that this is where many health information sites fail. There’s actually very little attention paid to how learners receive and process the information provided.

Back to first principles

Developing learning material should follow a thorough analysis of your target audience’s needs, attitudes, and environment. Many learners will prefer to access health-related learning materials online and in an asynchronous fashion. Considerations for developing good elearning will be critical. A book I recommend is eLearning by Designby William Horton. Many others are listed here.

Although I’ll be discussing elearning in some depth, it’s important to remember that elearning isn’t the only way to develop learning materials and it isn’t always the best way. Print and CDs/DVDs are viable sources of learning media and may be better for some populations (e.g., seniors, those without internet access, etc).

Some site design don’ts
Health information Web sites should not be about bombarding users with sponsored ads, increasing cognitive load, and rendering the useful information on the site less useful. They should not be about creating a scavenger hunt through links for what’s needed. If SEO trumps site usability and content quality, the site creators really don’t have the learner population in mind.

Some site design do’s
Good sites will create enduring tools and teach approaches for creating more effective partnerships between learners and their health care providers The guidance I’d like to offer, which isn’t very earthshaking, is that it’s worth returning to first principles of instructional design when developing health-related elearning.

In other words, your first question should not be “What do I want my learners to know?” but “What do I want my learners to be able to do?”

When you’ve identified the appropriate content to best support the functions learners will need to accomplish, it’s important to remember all the lessons you’ve learned about site usability. Sites should include:

Plain language

Readable fonts

Good use of white space

A liberal but appropriate use of graphics and media

Consistent navigation (consider using a combination of visual and text elements)

Scaffolded information, organized to reduce the amount of searching and scrolling a user needs to do

Interactive and personalized content

In the next post, I’ll describe supporting self-directed learning when creating interactive and personalized content.

More information about Web site usability considerations when the focus is on health can be found here.

3 responses to “Improving Health Literacy: It’s About Empowerment”

I agree with your suggestions for improving websites, but disagree with your use of “empowerment.” I’m with Jane Vella, who said, “Teachers do not empower adult learners; They encourage the use of the power that learners were born with.” Like Dorothy in the Wizard of Oz, consumers already are the owners and managers of their own health care strategies. We don’t own them, because we have no control — we just advise. They just don’t know they are the owners and managers. They don’t know what to do with this power. They don’t know how to behave in their own best interests.

I propose THAT is what we need to teach first. Perhaps, before “What do I want my learners to be able to do?” we should ask, “What does my learner want to accomplish?” That would hand them the power of patient-centered care.

I think we actually agree on most of this. I am using the term “empower” in a way it’s been used in the women’s movement where “Empowerment….refers to self confidence, self awareness and assertiveness. It relates to how individuals can recognise through analysing their experience how power operates in their lives, and gain the confidence to act to influence and change this.” A good discussion can be found here: http://www.generoyambiente.org/arcangel2/documentos/377.pdf.

You make a very good point that asking the learners what they want to accomplish is an important step of the process. It’s part of the “what’s the goal?” part of the learning diagram I provided and should be emphasized. As instructional designers when we ask this question, we should also make learners aware of what they can accomplish and then make sure we understand what their priorities are and where the true needs lie.

Creating sites/instructional materials that facilitate self-directed learning, which is what I’m proposing, is all about putting the learner in the “driver’s seat” and that means that target learners are part of the design process itself. Beta testing plays an important role.

I do submit however, that learners are aware of how to behave in their own best interests, once they are aware of the choices and resources available. But, and maybe this is what you’re saying, learners aren’t in it alone. The teacher is a facilitator and instruction needs to be scaffolded to support increasing learner independence, and to help learners understand how to use the resources that are available. I do believe that instructors can help model metacognitive processes.